March 2012

A Spotlight on Alzheimer’s –

Alzheimer’s disease—the most common form of dementia that gradually erodes memory, thinking and behaviour—doesn’t just impact the person with the disease. Its diagnosis can have a ripple effect that involves a much wider circle including family caregivers and, inadvertently, the organization where caregivers work. What can you do as a leader to support an employee caring for someone with Alzheimer’s? A lot thinks Barb Veder, Shepell·fgi’s Clinical Director of Regional Clinical Services.

What are the biggest challenges for a worker caring for someone with Alzheimer’s?

There are many challenges, both emotionally and physically. But in the context of work, it’s really about having enough time and flexibility in one’s working hours to help with daily care and to respond to emergencies if and when they arise.

An employee caring for someone with Alzheimer’s may also have to arrange care and deal with the medical, financial and legal issues of their loved one.

On top of this, employees may be taking care of other family members like younger children. As many are delaying having children until later in life, we’re seeing more and more “sandwich generation” adults in the workplace—those caring for kids and aging parents at the same time, including loved ones with Alzheimer’s. This constant juggling act can really deplete an employee’s time and energy. There’s simply too much to do and not enough time in a day to get it all done.

Can the role as caregiver impact your work?

Absolutely. While most people do their best to separate their work and home lives, they often spill over into one another.

An employee caring for someone with Alzheimer’s may have trouble concentrating on work because they’re worried their loved one may be in harm’s way while they are on the job (especially if they don’t have 24/7 care.

For example, they may fear their loved one will wander off, forget to eat, leave the stove on, etc.

They may also feel overwhelmed and overburdened with incidences that can happen at any time. Even if the person is there during an emergency, the time and effort spent on dealing with it can leave them physically and emotionally exhausted. What can a manager do to support an employee caring for someone with Alzheimer’s? I think showing empathy is really important. After all, you never know when you might be in the same situation. Try to be as flexible as possible so the employee can take the time when needed for care giving without worrying their job is in jeopardy. This might also mean allowing the employee to work from home occasionally or offering the option of working a compressed, shorter work week. You should also work together to create an “emergency plan” should an issue come up. For example, store project files on a shared drive (or ensure you get a copy of files) so if the employee is away, someone else on the team can fill in without disruption. Also, I think it’s wise to refer the employee to your organization’s Employee Assistance Program (EAP). Not only can they get support from a counsellor, but EAP also offers resources and information on Alzheimer’s and related support groups, home care, associations as well as long-term care facilities. It’s a great resource that costs the employee nothing to access. Finally, review government resources such as Compassionate Care Benefits or contact your Human Resources (HR) department to investigate care benefits your organization offers. What are the consequences of an unsupportive work environment? There are many, and they don’t just apply to caregivers—though the issues may be magnified for this group. Caregiver employees could become stressed, potentially resulting in poorer work performance, higher absenteeism or ultimately stress/disability leave

The employee’s ongoing stresses may also impact members of their team and lead to low morale within the department.

Finally, if a worker doesn’t feel supported, they may end up resigning or retiring early because they can’t balance work and their care giving duties.

SPOT THE SIGNS: Caregiver burnout

Caring for a loved one with Alzheimer’s isn’t easy-especially while trying to hold down a job. If your employee is displaying or has expressed that they are experiencing any of these symptoms, connect them with the organization’s Employee Assistance Program for support and resources.

Trouble sleeping or changes in sleep patterns

Gain or loss of weight, gain or loss in appetite

Feeling irritable or snapping at others

Depression-feeling blue or hopeless

Socially withdrawing or a disinterest in activities the employee used to be enthusiastic about

Physical and emotional exhaustion

Substandard work performance or not completing tasks at all

Frequent absence because of illness; headache, colds, flu

Emotional outbursts at work; tears, anger, defensiveness

Discussion of self harm or harming others

QUICK TIPS: Create a supportive work environment

What you can do now to create a workplace that welcomes family caregiversand encourages a healthier more balanced environment for all.

Explore flexible work schedule options that suit both the employee and the organization;

Engage employees and promote wellness by offering on-site health and wellness seminars or workshops. Topics offered by your Employee Assistance Program (EAP) include: Being in the Sandwich Generation,Caring for an Elderly Parent, and Finding Home Care and Community Resources;

Encourage employees to build social networks at the workplace so they can share experiences and, in sharing, overcome stress;

Support and encourage employees to take their allotted vacation time;

Encourage employees to establish boundaries between their work lives and home lives. Model this behaviour yourself as a leader;

Refer employees to national and local Alzheimer’s related resources such as the Alzheimer Society.

Alzheimer’s Alert (Canada):

In 2010 Canadian caregivers spent 259 million hours looking after a family member with dementia. By 2038, that number is expected to reach 756 million hours. Alzheimer Society

Dementia’s impact on family caregivers can be both psychological and physical: 15-32 per cent of caregivers have depression while it’s believed up to 75 per cent will develop a psychological illness. Alzheimer Society

A study of caregivers who work found 70 % experienced challenges dealing with their dual roles (i.e. caregiver and employee). Family Caregiver Alliance

The burden of caregiving often spills into the workplace reducing productivity by 18.5 % and increasing an employee’s chances of leaving the organization. Family Caregiver Alliance

Exactly what is a PPN (Preferred Provider Network)?

And how to make sure that a pharmacy PPN works for you?

As a plan sponsor, you have likely come across the acronym PPN and may recall that it stands for Preferred Provider Network. But have you ever stopped to consider what exactly a PPN means in terms of how it may affect your benefits plan and your plan members? A PPN is essentially a network of preferred providers –“preferred” in the specific providers become part of the network based on a agreed set of conditions. For instance, certain types of PPN’s offer you or your plan members access to additional and often discounted products and services.

Although the concept of a pharmacy PPN has been around for years, it is not as prevalent in Canada as PPN’s related to other benefit categories. Pharmacy PPNs can take many forms – like mail order pharmacies or networks of community pharmacies or the PPN designating an entire pharmacy chain as “preferred”. However, what the PPN models all have in common is that all parties involved come to an agreement that includes advantages for everyone:

For the plan sponsor; decreased costs

For the pharmacy; increased volume, and

For the plan member, incentives to choose the PPN pharmacy rather than a non-PPN pharmacy

Depending on the specific PPN model, decreased plan sponsor costs may come in the form of a combination of lower ingredients costs and/or lower dispensing fees. Then in theory, the pharmacy PPN sees increased volume because plan members are incented to choose the PPN pharmacy rather than a non-PPN pharmacy.

The key to establishing a successful pharmacy PPN is analysis, analysis…and more analysis.

Analysis in action….

Typical drug claim

Non-PPN Pharmacy

Pharmacy PPN Model #1: Mail Order Pharmacy

Pharmacy PPN model #2: Network of community pharmacies

Drug Cost

$49.00

$49.00

$46.00(lower drug cost with PPN)

Dispensing Fee

$11.00

$8.00 (lower dispensing fee with PPN)

$8.00 (lower dispensing fee with PPN)

Total

$60.00

$57.00

$54.00

Impact to plan member

Plan member pays 20% co-pay: $12

Plan member pays decreased co-pay of 10%: $5.70 Plan member is rewarded for using the mail order PPN by paying less: $5.70 rather than $12.00.

Plan member pays decreased co-pay of 10%: $5.40 Plan member is rewarded for using the PPN by paying less: $5.40 rather than $12.00.

Impact to plan sponsor

Plan sponsor pays the remaining:$48

Plan sponsor pays the remaining: $51.30 Despite lower dispensing fee, plan sponsor pays more for the claim than if the plan member had gone to the non-PPN pharmacy.

Plan sponsor pays the remaining $48.60 Despite lower drug cost and dispensing fee, plan sponsor still pays more than if the plan member had one to the non-PPN pharmacy.

In the above scenarios, we tell a cautionary tale. The co-pay for claims submitted to pharmacies in the PPN is 10% versus a co-pay of 20% for claims submitted to non-PPN pharmacies. The lower co-pay rewards plan members will have less out of pocket expenses than if they had accessed a non-PPN pharmacy. By contrast, the impact to the plan sponsor is that they pay slightly more than if the plan member had used a non-PPN pharmacy. In this scenario, the additional costs incurred by lowering the co=pay to motivate plan members to access the pharmacy PPN is not offset by additional cost savings from the PPN – from lower ingredient costs and lower dispensing fees.

When you consider entering a PPN arrangement (including mail order), analysis is the key success factor. Although a pharmacy PPN can be complex with many variables, there is light at the end of the tunnel. GSC effectively adjudicates all types of pharmacy PPNs, no matter how complex. Our rules-based adjudication system allows the flexibility to implement complicated plan designs combined with the responsiveness necessary to easily accommodate future changes. Bring it on…..